PPS 17.02Publiek private samenwerking tussen VSBN, BWC Maasstad ziekenhuis, Erasmus Medisch Centrum, Perimed Instruments

Projectleider: dr. Kees van de Vlies, BWC Maasstad ziekenhuis, Rotterdam

Consortium onderzoek gefinancierd met een PPS toeslag van de Topsector LSH en met een financiële bijdrage van de Nederlandse Brandwonden Stichting.

Gestart: januari 2018

Laser Doppler imaging (LDI) is the most widely used tool for the assessment of burn wounds. However, it is costly, cumbersome and slow to be able to accurately follow a change in tissue perfusion after fluid administration, which is the basis of the standard treatment of severe burns victims. Fluid resuscitation is crucial for survival and prevention of deepening of the burns wound. In this project two optical imaging devices will be introduced for diagnosis and treatment of the microcirculation in burn victims.

1.Laser Speckle Contrast Imaging (LSCI)

2.Incident Dark Field Imaging (IDF), a handheld video microscope.

LSI images microcirculatory perfusion. The diagnosis of the severity of burns will be investigated. Besides, the response during resuscitation and the success of wound healing will be determined. Also speckle images of the affected vs non affected skin will be compared.

The study will be divided in 3 workpackages:

Workpackage I: Validation; comparison of LSCI to LDI in healthy volunteers.

Workpackage II: Wound healing; comparison of LSCI and LDI to assess the severity of burn wounds. If possible IDF-microscope imaging will be used to assess tissue microcirculation.

Workpackage III: Resuscitation; the sublingual microcirculation (IDF) before and after fluid resuscitation will be compared in severe burns victims. Also LSCIwill be performed from burned and comparable non burned skin.

Innovativeness of the project:
To date, microcirculatory monitoring with Cytocam and laser speckle during the acute resuscitation phase has never been performed in severe burn patients. Applying these new non-invasive bedside techniques in the clinical setting of severe  burns patients will allow us to see how the current resuscitation regime (based on targeting systemic macro circulatory targets) effects the  microcirculation and tissue perfusion. If the results can confirm that the current resuscitation regime is sub-optimal, then this will strengthen the motivation for changing the long standing existing practice. A change in longstanding practice, based on new knowledge obtained in this project, has the potential  to lead to a great improvement in clinical care and possibly open the way to a more physiological optimization of fluid administration for the burns patient. Since these new techniques are simple and fast to use this can potentially revolutionize burn resuscitation care. Has the Parkland formula come to a dead end?